ADHD is Real

Australia’s National Health and Medical Research Council, along with organisations in other parts of the world recognises that Attention-Deficit/Hyperactivity Disorder (ADHD) is a real, brain-based medical disorder. These organizations also concluded that children and adults with ADHD benefit from appropriate treatment. [1,2,3,4,5,6,7]

ADHD is a Common, Non-Discriminatory Disorder

ADHD is a non-discriminatory disorder affecting people of every age, gender, IQ, religious and socio-economic background.

In 2011, the Centers for Disease Control and Prevention reported that the percentage of children in the United States who have ever been diagnosed with ADHD is now 9.5%. [8] Boys are diagnosed two to three times as often as girls.

Among adults, the Harvard/NIMH National Comorbidity Survey Replication found 4.4% percent of adults, ages 18-44 in the United States, experience symptoms and some disability. [9]

ADHD, AD/HD, and ADD all refer to the same disorder. The only difference is that some people have hyperactivity and some people don’t.

Diagnosing ADHD is a Complex Process

In order for a diagnosis of ADHD to be considered, the person must exhibit a large number of symptoms, demonstrate significant problems with daily life in several major life areas (work, school, or friends), and have had the symptoms for a minimum of six months.

To complicate the diagnostic process, many of the symptoms look like extreme forms of normal behavior. Additionally, a number of other conditions resemble ADHD. Therefore, other possible causes of the symptoms must be taken into consideration before reaching a diagnosis of ADHD.

What makes ADHD different from other conditions is that the symptoms are excessive, pervasive, and persistent. That is, behaviors are more extreme, show up in multiple settings, and continue showing up throughout life.

No single test will confirm that a person has ADHD. Instead, diagnosticians rely on a variety of tools, the most important of which is information about the person and his or her behavior and environment. If the person meets all of the criteria for ADHD [10,11], he or she will be diagnosed with the disorder.

Other Mental Health Conditions Often Occur Along With ADHD

Up to 30% of children and 25-40% of adults with ADHD have a co-existing anxiety disorder. [12]

Experts claim that up to 70% of those with ADHD will be treated for depression at some point in their lives. [13]

Sleep disorders affect people with ADHD two to three times as often as those without it. [14]

ADHD is Not Benign

ADHD is not benign.[15] Particularly when the ADHD is undiagnosed and untreated, ADHD contributes to:

According to Dr. Joseph Biederman, professor of psychiatry at Harvard Medical School, ADHD may be one of the costliest medical conditions in the United States: “Evaluating, diagnosing and treating this condition may not only improve the quality of life, but may save billions of dollars every year.” [34]

ADHD is Nobody’s FAULT

ADHD is NOT caused by moral failure, poor parenting, family problems, poor teachers or schools, too much TV, food allergies, or excess sugar. Instead, research shows that ADHD is both highly genetic (with the majority of ADHD cases having a genetic component), and a brain-based disorder (with the symptoms of ADHD linked to many specific brain areas). [35]

The factors that appear to increase a child’s likelihood of having the disorder include gender, family history, prenatal risks, environmental toxins, and physical differences in the brain. [36]

ADHD Treatment is Multi-Faceted

Currently, available treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, behavioral interventions, education or training, and educational support. Usually a person with ADHD receives a combination of treatments. [37,38]

No doubt you have heard several times that genes play an important part in ADHD. But what exactly does that mean? Well, it means that different types of genetics studies have identified links between ADHD and certain genes. There is also important research underway concerning the role of environmental factors and their interplay with genes, but more of that later.

Behaviour genetics investigates the contribution of genes and the environment to individual differences in behaviour. It examines familiality (Does ADHD run in families?) and heritability (Does ADHD get passed on?) And many studies confirm the highly familial nature of ADHD, with first-degree relatives displaying a four to five fold risk of ADHD compared to the general population.

Twin studies and adoption studies are also valuable. Adopted children share genes but not the environment with their biological parents. Any similarity between these adopted children and biological parents could therefore be attributed to their shared genes. In the same way, similarities between adopted children and their adoptive parents could be attributed to the environment they share.

Adoption studies have found that adoptive parents of children with ADHD display less behaviours of hyperactivity, and do better on standardized tests of attention than the biological parents. This supports the belief that ADHD has a genetic component.

Twin studies have also investigated the genetic components of ADHD. When conducting twin studies, researchers consider behaviours which are highly common to identical twins to be influenced by genetics, with those common to non-identical twins to be caused by environmental factors. In reviewing the numerous twin studies on the heritability of ADHD, researchers have concluded that up to 90% of the cause of ADHD can be attributed to genetic factors.

Molecular genetics research of ADHD includes linkage and association studies.

Linkage studies aim to pinpoint the location of individual genes responsible for a particular disease. This has not been successful with ADHD, due to the multiple genes involved.

However association studies in ADHD have followed a candidate gene approach, which has been very successful in identifying groups of risk genes for ADHD. Focusing on the genes of neurotransmitter systems such as dopamine, serotonin and noradrenalin, it has identified DRD4, DRD5 and DAT1 as risk genes for ADHD.

Researchers in the field of genetics are presently developing methods of combining behaviour genetics with molecular genetics research. These combined studies could, in the future, assist in the identification of specific genes implicated in ADHD, assisting the processes of diagnosis and treatment.

A 2010 article published in the Melbourne University Law Review addresses the issue of ADHD in the workplace. I was particularly pleased and proud to read it because it quotes my Masters research.

For those who wish to read the article in its entirety, here is the reference:
IT JUST DOESN’T ADD UP: ADD/ADHD, THE WORKPLACE AND DISCRIMINATION. Melbourne University Law Review 34 No. 2, 2010. Authors : Bruce Arnold, Patricia Easteal, Simon Easteal & Simon Rice,

The authors start by making the valuable point that workplace conditions which appear fair can often discriminate against people who find conforming to them difficult or even impossible, due to neurological or cognitive differences. Furthermore, people who experience discrimination are required to prove this by using the Australian Disability Discrimination Act (DDA). This can be problematic for those with so-called ‘invisible’ difficulties such as ADHD, because of the attached stigma, and the way the DDA is interpreted. An alternative approach, as advocated by the authors of this article, is to treat ADHD within a framework that recognises different abilities (in the same way that gender and race differences are treated), rather than classing it as a disability.

Infrastructure and employment practices in our current society were designed at a time when there was little acknowledgement of genetic diversity. Conditions that suit the majority are considered to be fair. As a result, people who do not fit in, and require special arrangements appear, and are labelled disabled. However, the acknowledgement that women, for example, are disadvantaged in the workplace does not label them as disabled, rather as having different needs. Is it possible that neurodiversity could receive the same treatment as women, when attempting to provide fair working conditions? Workplaces that accommodate women using flexible working conditions benefit greatly from the contributions made by these women. In the same way, workplaces that provide flexible working conditions for people with ADHD will be enriched by the many positive attributes they display.

We know from the research that ADHD can reduce employment opportunities for some. People with ADHD can find it difficult to complete tasks without digressing to another activity; time management can be problematic; they may hyper-focus on one task to the detriment of other equally important work; they appear to procrastinate, particularly with tedious tasks; they may fidget and pace. In addition, they may experience difficulty with social interactions – talking excessively and appearing over-emotional. On a positive note, there are many characteristics of people with ADHD, and these should provide incentive for changes in the workplace. As this article argues, the flipside of what is described in the literature as an ‘impairment’ of executive functioning may be a creative genius with a richness of wandering thoughts that could greatly benefit an organisation. Tapping into diversity can improve organisational performance.

Anti-discrimination law in Australia places ADHD in a disability framework, based on the idea that ADHD is a deficit relative to a norm. This approach compares a person who has a disability with a person who does not, or against a standard that is ‘objectively’ reasonable. The law anticipates that people with a characteristic that differs from the ‘norm’ will suffer for it. Therefore disability discrimination laws operate to protect, not to promote. They endorse a positive view of a difference indirectly – by reprimanding those who take a negative view of that difference.

As this article points out, however, legislation that prohibits discrimination on the ground of race or sex is designed to negate the concept of a ‘normal’ sex or race and to promote equal, non-differential treatment. Therefore, when a person complains of sex discrimination, they identify as having a particular sex, and claim they have been treated differently because of this. Disability discrimination, on the other hand, establishes a deficit, which does not measure up to the accepted ‘ability’. Instead of protecting people who are deemed less able, the article proposes that they be accepted for a different ability. If there is unfair treatment in the workplace, it should be addressed within a framework of neurodiversity, that recognises people as differently abled, rather than as disabled – in the same way that people are recognised for being differently gendered or having different cultural backgrounds.

Using this approach, a person with ADHD would not be labelled as an employee with a ‘problem’, but as an employee with abilities. If performance problems arose, the adjustments made would be designed to accommodate diversity, rather than to compensate for disability.

In conclusion, the article points out that modern workplaces are more diverse than ever before, and a simple ‘one-size-fits-all’ approach to management is no longer appropriate. Workplaces could and should be adjusted to accommodate neuro-cognitive diversity.